Diagnosis of acute cholecystitis
Last reviewed: 23.04.2024
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Clinical diagnosis of acute cholecystitis in children is usually not informative, as the disease develops suddenly. When examining the patient determine the forced position, icterus of the skin. Palpator is the area of maximum abdominal tenderness (right hypochondrium), the size of the liver and spleen.
[Laboratory diagnostics of acute cholecystitis in children
Clinical blood test:
- increase in the number of leukocytes - in the catarrhal form of acute cholecystitis - 10-12x10 9 / l, with phlegmonous and gangrenous - 15-20x10 9 / l and more;
- neutrophilia with a shift to the left;
- ESR from 20-30 to 50-60 mm / h.
Urine analysis - increase in the concentration of bile pigments. Stool analysis is the absence of stercobilin.
Biochemical blood test:
- increase in bilirubin content due to direct (conjugated) fraction;
- increase in the concentration of excretory enzymes serving as biochemical markers of cholestasis: alkaline phosphatase (especially hepatic isoenzyme), y-glutamyltranspeptidase, leucin aminopeptidase, etc .;
- increase in the concentration of proteins of the acute phase of inflammation: prealbumin, beta 2 -glycoprotein, C-reactive protein, etc .;
- increased activity of transaminases.
Instrumental diagnostics of acute cholecystitis in children
Ultrasound can detect signs of acute cholecystitis: thickening of the gallbladder walls more than 3-4 mm, "doubled" contour of the wall and an increase in the size of the organ, perivesical fluid. With a dynamic study, you can judge the form of the inflammation of the gallbladder.
When laparoscopic examination in the case of catarrhal acute cholecystitis, the serous cover of the bottom and body of the gallbladder is hyperemic, the vessels are injected. The bubble is tense and enlarged. With phlegmonous form of acute cholecystitis, the penis of the organ is sharply edematous and hyperemic, subserious hemorrhages are visible, fibrin overlays on the gallbladder and surrounding organs. In the right hepatic space and the right lateral canal, a yellow effusion is formed. Gangrenous inflammation, in addition to the features listed, characterizes the formation of foci of necrosis on the wall of the gallbladder.
Differential diagnostics
Acute cholecystitis in children must be differentiated from diseases that occur against the background of acute and sudden pain in the abdomen: appendicitis with acute, pancreatitis, acute, peptic ulcer, right-sided pleurisy, right-sided pneumonia, renal colic right-sided.